Provider Demographics
NPI:1861047888
Name:PATEL, HITESHKUMAR R
Entity type:Individual
Prefix:
First Name:HITESHKUMAR
Middle Name:R
Last Name:PATEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1034 DORAL DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085-6130
Mailing Address - Country:US
Mailing Address - Phone:248-979-4324
Mailing Address - Fax:586-279-1215
Practice Address - Street 1:11460 E 12 MILE RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-2631
Practice Address - Country:US
Practice Address - Phone:586-722-2842
Practice Address - Fax:586-279-1215
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-06
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302037593183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist